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Expert vary on Baumhammers diagnoses

Friday, May 19, 2000

By Christopher Snowbeck and Anita Srikameswaran, Post-Gazette Staff Writers

How could three psychiatrists not agree on a diagnosis for Richard Baumhammers but still find him incompetent to stand trial?

Baumhammers ruled not fit to go on trial


It's possible, experts said yesterday, for several reasons -- chief among them that three psychiatrists with different areas of expertise may have seen a variety of symptoms on separate days. And in the end, their diagnoses were not that far apart.

Baumhammers, the Mt. Lebanon man accused of killing five people and wounding another in an April 28 shooting spree, was examined by Dr. Christine Martone, director of the Allegheny County Behavior Clinic, and Drs. Sabato A. Stile and David E. Ness.

Martone testified last week that she believed Baumhammers is a paranoid schizophrenic. Stile testified Wednesday that Baumhammers suffers from psychotic thought disorder, while Ness testified that Baumhammers seems to suffer from paranoia, often called delusional disorder.

The link is that all three are psychotic disorders, and both the intense fear of paranoia cited by Ness and the disordered thoughts mentioned by Stile are aspects of schizophrenia, which was the term used by Martone, said Dr. Rohan Ganguli, chief of clinical services at Western Psychiatric Institute and Clinic.

Different psychiatrists could have gotten slightly different readings because of the timing of their interviews, which occurred on different days, he added.

"What [Baumhammers] said to one person and what he said to another and why he would have shared more information with one psychiatrist than another" are all factors in different technical diagnoses, Ganguli said. Doctors are subject to "the patient's willingness to share information with you."

Plus, in any branch of medicine, there is often some level of disagreement when two or three doctors render their opinions, said Dr. Jonas Rappeport, a founder of the American Academy of Psychiatry and Law, a professor at Johns Hopkins University and the retired chief medical officer for the Circuit Court of Baltimore City.

Consensus may be difficult to achieve in diagnosing mental illnesses because psychiatrists have to work largely from the patient's responses and behavior.

"We don't sometimes have the physical symptoms that doctors can see on an X-ray or MRI, or have a blood test, to corroborate an opinion," Rappeport said. "People don't always present [symptoms] very clearly and you can split hairs."

One psychiatrist with a background in research and evaluation of schizophrenic patients may quickly decide that is the appropriate diagnosis, while another doctor may want more information before giving the patient that diagnosis, with its attendant stigma.

Dick Jevon, a board member of the Southwestern Pennsylvania Chapter of the National Alliance for the Mentally Ill, said he wasn't surprised by the differing diagnoses. Family members of mentally ill people see drastic changes in symptoms not just from week to week and day to day, but hour to hour, he said.

Another complicating factor, Jevon suggested, is that Baumhammers' illness may not have stabilized, given his relatively young age of 34.

By that age, schizophrenia would already have set in with most men who have the disease, Ganguli said, but he agreed that Baumhammers is in an age group where many men first suffer from delusional disorder.

Although there were some differences in the diagnoses, it is worth noting that all three psychiatrists found Baumhammers incompetent to stand trial, Rappeport said.

As to whether Baumhammers could have fooled the three doctors, Rappeport doubts it.

Rappeport, whose career in forensic psychiatry has spanned 45 years and included the case of John Hinckley, who tried to assassinate President Reagan, said that it's unlikely someone could fake a mental illness well enough to fool a psychiatrist.

"And if you have three, I think it would be relatively impossible," he said.

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